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Report: Most Care in Rural EDs Not Handled by Emergency Medicine Specialists

EDs in rural areas feature some significant differences from those in cities or suburbs, according to a new study.

Staff members are less likely to be emergency medicine specialists outside of metropolitan areas, and advanced practice providers (APP) provide much more of the care compared to physicians, according to the report.

"Emergency departments are an especially vital safety net for patients in rural settings," explained M. Kennedy Hall, MD, MHS, lead author of the report and assistant professor in the Department of Emergency Medicine at the University of Washington School of Medicine. "This study shows that there is an opportunity to address emergency medicine workforce challenges and narrow any potential gaps in training for those providing emergency care.”

The analysis noted that 61% of 58,641 clinicians providing care in EDs were emergency medicine specialists and 14.3% were generalist physicians or those from other specialties (41.7% family practice and 19.9% internal medicine). Another 24.5% were APPs, primarily physician assistants (68.4%) and nurse practitioners (31.5%).

Where different types of providers tend to practice varied markedly, according to the report. Urban counties had a markedly higher proportion of emergency physicians (63.9%) vs. rural counties (44.8%). At the same time, 27.1% of the 2,291 U.S. counties or equivalent counties included in the analysis employed no emergency medicine clinicians, and 41.4% of counties had no emergency physicians reimbursed by Medicare fee-for-service Part B.

"Our analysis revealed that more than one-third of emergency department clinicians are someone other than an emergency physician," Hall emphasized. "This points to the need for a broader approach to emergency care training.”

On the other hand, data from the 2014 Medicare Public Use Files dataset of 932,243 physicians, which includes 58,641 unique emergency medicine clinicians, showed the field is growing. The study identified at least 20,000 more emergency physicians than a decade ago.

“This work establishes a new baseline estimate of the emergency care workforce, encompassing nearly 60,000 emergency medicine clinicians, of whom fewer than two in three were emergency physicians,” the study authors concluded.

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